You are treating and transporting a 26-year-old female involved in an MVA. She has multiple injuries, but all associated hemorrhage is controlled. The patient is exhibiting signs and symptoms of hypovolemic shock. During treatment and transport, you infuse one liter of lactated Ringer's solution, and the patient remains hypotensive. Once at the hospital, which of the following is most likely to be administered immediately upon arrival?

Correct Answer: B

Rationale: The correct answer is B: O-negative packed red blood cells. Packed red blood cells are the most appropriate choice for a patient in hypovolemic shock as they help increase the oxygen-carrying capacity of the blood. In this scenario, the patient's hemorrhage is controlled, indicating a need for red blood cells rather than whole blood. O-negative blood is universally compatible, reducing the risk of transfusion reactions. Plasma-containing products like whole blood (choice A) may not be necessary if there is no active bleeding or coagulopathy present. O-positive packed red blood cells (choice C) may not be compatible with the patient's blood type, risking transfusion reactions. O-positive whole blood without plasma (choice D) may not provide adequate oxygen-carrying capacity needed in hypovolemic shock.

Correct Answer: D

Rationale: The correct answer is D: Presence of deep tendon reflexes. In hypotension due to spinal cord injury, deep tendon reflexes are typically absent below the level of injury. This is known as spinal shock. The presence of deep tendon reflexes suggests intact spinal cord function and points towards a cause of hypotension other than spinal cord injury. Prispism (A) is not a physical finding associated with hypotension or spinal cord injury. Bradycardia (B) can be a common finding in spinal cord injury due to autonomic dysregulation. Diaphragmatic breathing (C) is also not directly related to hypotension or spinal cord injury.

Correct Answer: D

Rationale: The correct answer is D: Hemorrhage into the chest or abdomen. In this scenario, the man has no open wounds or obvious fractures, ruling out subdural and epidural hematomas. A transected spinal cord would result in neurological deficits rather than shock. Hemorrhage into the chest or abdomen can lead to significant blood loss causing shock, especially in trauma patients. This is supported by the mechanism of injury (motorcycle crash) and the absence of external bleeding.

Correct Answer: C

Rationale: Rationale: C is correct because blood transfusion can be delivered through an intraosseous access in pediatric resuscitation due to the rapid and reliable infusion of fluids and medications. A is incorrect as intraosseous access is considered early in pediatric resuscitation without a set number of percutaneous attempts. B is incorrect as cut down at the ankle is not a preferred access technique in pediatric resuscitation. D is incorrect as internal jugular cannulation is not the next preferred option after failed percutaneous venous access in pediatric resuscitation.

Correct Answer: C

Rationale: The correct answer is C: Be treated for hypovolemic shock. The patient's low blood pressure (60/40) and rapid pulse (140 bpm) indicate hypovolemic shock due to significant blood loss from the crash. Treating hypovolemic shock involves administering fluids to restore blood volume and improve perfusion to vital organs. This is crucial to stabilize the patient's condition before further interventions. Choice A (Undergo exploratory celiotomy) is incorrect as it is not the immediate priority in this case. Choice B (Be treated for neurogenic shock) is incorrect because the patient's symptoms are more indicative of hypovolemic shock. Choice D (Undergo immediate nasotracheal intubation) is also incorrect as the priority should be addressing the hypovolemic shock first to stabilize the patient's condition.